Understanding contraceptive choices among a cohort of HIV-positive women

Transcription

1 Understanding contraceptive choices among a cohort of HIV-positive women Malika Sharma, MD FRCPC with Blitz S, Walmsley S, Raboud J, Money D for the CTN 236 investigators January 13, 2014

2 Conflict of Interest Disclosure In the past 2 years I have been an employee of: The University of Toronto In the past 2 years I have been a consultant for: N/A In the past 2 years I have held investments in the following pharmaceutical organizations, medical devices companies or communications firms: N/A In the past 2 years I have been a member of the Scientific advisory board for: N/A In the past 2 years I have been a speaker for: N/A In the past 2 years I have received research support (grants) from: CIHR In the past 2 years I have received honoraria from: N/A I agree to disclose approved and non-approved indications for medications in this presentation: YES I agree to use generic names of medications in this presentation: YES

3 Contraception & HIV: Background Women >50% of world s 33.3 million people living with HIV/AIDS Improvements in life expectancy with combined antiretroviral therapy (ART) Several contraceptive methods may interact with HIV infection or ART in clinically significant ways Global Report 2010 Health Canada 2007 UNAIDS 2010

4 HIV & Contraception Interactions Potential changes in contraceptive efficacy/ drug interactions Impact on STI transmission and HIV acquisition Possible impacts on progression of HIV itself

5 Objective To understand associations between baseline demographic & HIV-related data and contraceptive choices among a cohort of Canadian women participating in the CTN236: HPV Vaccine in HIV trial

6 Methods CTN236: HPV Vaccine in HIV trial Multicenter, 27-month prospective, single arm open-label study Designed to assess HPV vaccine effectiveness Data regarding contraceptive use abstracted from baseline/screening data for sexually active, pre-menopausal women

7 Methods Variables examined: Demographics Use and type of ART CD4 count, viral load Hepatitis B co-infection Details on substance use Sexual history Details on contraception use collated & descriptive summary compiled

8 Participants 377 women with screening demographic data available 209 women aged included in analysis 168 women did not meet inclusion criteria 24 (6.3%) premenarchal 36 (9.5%) never had intercourse 29 (7.7%) postmenopausal 79 (21.0%) not sexually active in past year

9 Demographic information 87% reported a previous pregnancy 89% reported at least one method of current contraception 82.3% reported use of barrier protection (with or without other methods) 73% reported condom use most or all of the time

10 General patterns of contraception use Hormone None Other 3.8% 5.3% 8.1% Barrier+Hormone 14.8% N Barrier+Other 14.8% Barrier 53.1%

11 Hormonal Contraceptive Use 16.7% (35/209) currently using hormonal contraception (HC) Majority (80%) in combination with barrier protection 75% (156/209) of women reported HC use in the past

12 Demographic & sexual history Barrier Hormone Barrier + Barrier + None Only Only Hormone Other Other Variables n=11 n=111 n=7 n=28 n=18 n=34 Age (Years) 39 (35-42) 37 (31-44) 32 (28-34) 31 (26-38) 37 (34-40) 39 (35-44) Days since last sexual activity At least 1 new partner in last 12 months Any STI ever 30 (1-182) 8 (4-77) 7 (2-7) 7 (3-14) 12 (2-30) 7 (2-30) 2 (18%) 30 (27%) 0 11 (39%) 1 (6%) 7 (21%) 9 (82%) 83 (75%) 5 (71%) 20 (71%) 18 (100%) 32 (94%)

13 Patterns of Current HC use Type of Current HC Depo Provera Combination Est/Prog pills Progestin only Nuvaring Ortho Evra Patch

14 Variations in contraceptive use by race/ethnicity White Black Aboriginal Other 0 None (n=11) Barrier only (n=111) Hormone only (n=7) Barrier + hormone (n=28) Other (n=18) Barrier + other (n=34)

15 HC use and smoking Current smokers among HC users Smoker Non-smoker

16 HIV-related factors Barrier Hormone Barrier + Barrier + None Only Only Hormone Other Other Variables n=11 n=111 n=7 n=28 n=18 n=34 CD4 at Screening 330 ( ) 495 ( ) 660 ( ) 515 ( ) 470 ( ) 470 ( ) (cells/mm 3 ) CD4 < (1%) (6%) 1 (3%) CD4 >500 7 (64%) 48 (43%) 2 (29%) 10 (36%) 7 (39%) 21 (62%) CD4 Nadir (cells/mm 3 ) 170 (82-275) 244 ( ) 360 ( ) 340 ( ) 250 ( ) 220 ( )

17 Viral Load Suppression & Contraceptive Use Percentage None (n=11) Barrier only (n=111) Hormone only (n=7) Barrier + hormone (n=28) Other (n=18) Other (n=34)

18 ART Status among cohort Variables Ever on ART Current PI Based regimen Current NNRTI Based regimen Barrier Hormone Barrier + Barrier + None Only Only Hormone Other Other n=11 n=111 n=7 n=28 n=18 n=34 11 (100%) 97 (89%) 7 (100%) 24 (86%) 18 (100%) 29 (88%) 4 (36%) 42 (38%) 3 (43%) 8 (29%) 3 (17%) 12 (35%) 1 (9%) 21 (19%) 2 (29%) 2 (7%) 5 (28%) 7 (21%)

19 Discussion Contraception use was high (89%) Barrier protection rates were moderately high (82.3%) with only 73% reporting consistent use Findings of concern: Concomitant barrier contraception only 71.3% with other methods High smoking rates among women on HC Poor condom adherence among women on HC 31.4% every time and 34.3% most of time

20 Limitations Small sample size within certain subgroups Limited to descriptive analysis only at this point A sub-analysis of a study on HPV vaccine, not specifically designed to address contraceptive use or changes over time

21 Conclusions Contraception is an important concern for HIV-positive women Co-morbid risks (ie smoking, other STIs) must be considered Counseling around contraceptive choices is crucial for HIV-positive women

22 Thank you!

23 Acknowledgements Sandra Blitz Dr. Deborah Money Janet Raboud Dr. Sharon Walmsley